Provider Demographics
NPI:1417906835
Name:ALAM, MUHAMMAD MANSOOR (MD)
Entity Type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:MANSOOR
Last Name:ALAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7065 N. MAPLE AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720
Mailing Address - Country:US
Mailing Address - Phone:559-554-2100
Mailing Address - Fax:559-554-2114
Practice Address - Street 1:7065 N. MAPLE AVE
Practice Address - Street 2:STE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-554-2100
Practice Address - Fax:559-554-2114
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091113207R00000X, 208M00000X
CAC-144556207R00000X
CAC144556207RH0000X, 207RX0202X
OH5135086241207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2625574Medicaid
06213367OtherECFMG
I42163Medicare UPIN
AL4169771Medicare ID - Type Unspecified
OH2625574Medicaid